Provider Demographics
NPI:1306632310
Name:SYLVESTER, RYAN EDWARD (MS, LAC, NCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:EDWARD
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-3237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19778 BOYS HOME RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:AR
Practice Address - Zip Code:72749-9712
Practice Address - Country:US
Practice Address - Phone:888-289-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2309011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health